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Hiring doctors' assistants will lead to further demoralisation of a very unhappy workforce

Obstetrician and Gynaecologist Jonathan Gaughran says the current feeling amongst his junior doctor peers is that introducing doctor assistants is both unjust and insulting, particularly as they are starting on higher salaries than a first year doctor.

They expect to see somebody who has studied the workings of the human body, what happens when it goes wrong and what tools can be used to diagnose such problems. The final step is to safely utilise medicines and procedures in a measured and practiced way in order to cure or alleviate the pathology.

A physicians assistant (PA) has not gone through the rigorous training it takes in order to perform this task, but instead depends on pattern recognition of common illnesses, working within a narrow speciality of medicine. It is the patient who presents with an unusual illness, or a common illness with an unusual presentation who will receive suboptimal care from a physician’s assistant.

Misleading and unethical

It is the patient whose illness stretches across the realms of one niche area of medicine who will be failed by physicians assistants. If one looks at numerous studies from the US where physicians assistants are widely used, many patients were not aware it was not a doctor who was seeing them, which is both misleading and unethical.

Those who did know it was a physicians assistant stated that they were dissatisfied by not seeing a doctor. The government may argue that PAs are aimed at reducing patients dissatisfaction with waiting times, and also to alleviate doctors already crippling workload.

Well, if research suggests patients are not satisfied by seeing a PA, then surely doctors are? The word ‘assistant’ by definition suggests these health care providers to be subordinate to doctors. Which is curious considering their starting salary in Ireland is currently proposed to be nearly €10,000 per annum more than a first year doctor.

Higher pay

€10,000 per annum for 2 years of study versus a minimum of five.

The current feeling amongst my junior doctor peers is that this is both unjust and insulting which will only lead to further demoralisation of a very unhappy workforce.

Why else might not junior doctors appreciate their assistant? Medicine is an apprenticeship. We are both actively encouraged, and for most people enjoy demonstrating the art of medicine to students and watching them grow into proficient clinicians through their years of medical school.

In order to nurture their potential it takes time. Time which would now be spent listening to the physician’s assistant assessment of a patient and ordering investigations which they do not have the authority to request. Should that be the wrong test and the patient comes to harm, who would responsibility lie with?

As such, in order to reduce that risk, most doctors I have worked with would want to see the patient themselves, therefore duplicating work, adding to doctors responsibilities while subtracting from our time spent with our students.

Vacancies in Ireland’s health service

The government may argue that it’s simple maths. There are current doctors vacancies they simply can’t fill and therefore patients suffer.

One must ask why is there such a deficit of doctors?

The answer: Australia and New Zealand. Irish and English doctors are fast realising that they can earn a better wage, be supported through their professional exams and strike a better work-life balance abroad.

So why would they stay? Many do, out of loyalty to their community and a want of improving the HSE. The question is how many of these will last the growing cuts in wages, the soaring costs of being a doctor, and now the added complexity of being given an assistant you neither asked for, nor wanted.

Jonathan Gaughran was born in Dublin and studied science in Trinity College, followed by medicine in University of Southampton. He completed Academic Foundation training (internship) in Liverpool splitting his time between clinical and research and also Neurosurgery in Newcastle for a year. He then trained as an emergency registrar in Melbourne. Jonathan now lives in London working as an Obstetrician and Gynaecologist.

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